基于大型综合医院单中心乳腺癌手术病人10年诊治和生存分析  

Diagnosis,treatment and survival of breast cancer patients in single large hospital:a 10-year analysis

作　　者：陈小松[1] 李帅 吴佳毅[1] 黄欧[1] 柴维敏[2] 姚洁洁[3] 朱樱[3] 许赪[4] 陈佳艺[4] 瞿晴[5] 费晓春[6] 丁晓毅[7] 林琳[8] 张男[1,9] 方琼[10] 何建蓉[1] 朱丽[1] 李亚芬[1] 陈伟国[1] 沈坤炜[1] CHEN Xiaosong;LI Shuai;WU Jiayi;HUANG Ou;CHAI Weimin;YAO Jiejie;ZHU Ying;XU Chen;CHEN Jiayi;QU Qing;FEI Xiaochun;DING Xiaoyi;LIN Lin;ZHANG Nan;FANG Qiong;HE Jianrong;ZHU Li;LI Yafen;CHEN Weiguo;SHEN Kunwei(Comprehensive Breast Health Center,Department of Surgery,Rujin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Radiology,Rujin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Ultrasound,Rujin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Radiotherapy,Rujin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Oncology,Rujin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Pathology,Rujin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Interventional Radiology,Rujin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Laboratory Medicine,Rujin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Nursing,Rujin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Faculty of Nursing,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院外科,乳腺疾病诊治中心,上海200025 [2]上海交通大学医学院附属瑞金医院放射科,上海200025 [3]上海交通大学医学院附属瑞金医院超声科,上海200025 [4]上海交通大学医学院附属瑞金医院放疗科,上海200025 [5]上海交通大学医学院附属瑞金医院肿瘤科,上海200025 [6]上海交通大学医学院附属瑞金医院病理科,上海200025 [7]上海交通大学医学院附属瑞金医院放射介入科,上海200025 [8]上海交通大学医学院附属瑞金医院检验科,上海200025 [9]上海交通大学医学院附属瑞金医院护理部,上海200025 [10]上海交通大学医学院护理学院,上海200025

出　　处：《外科理论与实践》2021年第2期149-158,共10页Journal of Surgery Concepts & Practice

基　　金：国家自然科学基金(81772797);上海教育委员会高峰高原计划—研究型医师(20172007);瑞金医院“广慈卓越青年培养计划”项目(GCQN-2017-A18)。

摘　　要：目的:评估瑞金医院乳腺癌手术病人的诊治和预后,为进一步临床诊疗和研究开展提供基础。方法:入组2009年1月至2018年12月在我院乳腺疾病诊治中心手术治疗的非晚期乳腺癌病人,分析临床病理特征、保乳手术、前哨淋巴结活检(sentinel lymph node biopsy,SLNB)以及在不同手术年份的变化趋势。用Kaplan-Meier曲线分析并比较不同治疗方案乳腺癌病人的5年和10年无病生存(disease free survival,DFS)和总生存(overall survival,OS)。结果:共8210例入组。乳腺原位癌为959例(11.7%)。在未接受新辅助治疗的7549例病人中,淋巴结阴性为5379例(71.3%),0期和I期分别为949例(12.6%)和2964例(39.3%)。2377例(29.0%)接受保乳手术,占乳腺癌手术比例从2009年的16.5%上升到2013年的34.8%。4149例(52.5%)接受SLNB,从2009年的0.6%上升至2018年的69.3%。2009年至2018年入组的所有乳腺癌病人均进行完整随访。中位随访46个月。5年和10年DFS率分别为87.6%和80.5%;5年和10年OS率分别为94.2%和90.7%。2009年至2014年手术治疗的3800例乳腺癌病人,中位随访时间79个月,5年DFS率和OS率分别为86.9%和93.1%,10年DFS率和OS率分别为79.1%和88.4%。结论:瑞金医院乳腺癌手术病人的保乳手术和SLNB比例在10年间逐渐提高。在现代乳腺癌治疗模式下,乳腺癌病人5年OS率超过93%。本研究结果可指导乳腺癌临床诊治策略的制定和进一步研究。Objective:To analyze the diagnosis,treatment and prognosis of breast cancer patients in Ruijin Hospital for further clinical management and study.Methods Non-metastatic breast cancer patients with surgical treatment in our hospital were included from January 2009 to December 2018.Clinicopathological features of enrolled patients and changing trend of different surgery including breast conserving surgery and sentinel lymph node biopsy(SLNB)in the period of this study were analyzed.Kaplan-Meier curve analysis was used to compare 5-year and 10-year disease free survival(DFS)and overall survival(OS)of patients with different treatments.Results This study had 8210 patients.There were 959(11.7%)patients with in situ disease and 5379(71.3%)patients with negative lymph node in 7549 patients without neoadjuvant therapy.There were 949(12.6%)cases and 2964(39.3%)cases with breast cancer at stage 0 and stage I,respec-tively.A total of 2377(29.0%)patients underwent breast conserving surgery with increase from 16.5%in 2009 to 34.8%in 2013.The patients with SLNB were 4149 cases(52.5%)from 0.6%in 2009 to 69.3%in 2018.All patients from 2009 to 2018 achieved complete follow-up with a median follow-up of 46 months:5-year and 10-year DFS were 87.6%and 80.5%;5-year and 10-year OS were 94.2%and 90.7%,respectively.There were 3800 patients with surgery followed from year2009 to 2014 with a median-follow-up of 79 months:5-year DFS rate and OS rate were 86.9%and 93.1%;10-year DFS rate and OS rate were 79.1%and 88.4%,respectively.Conclusions Both rates of breast conserving surgery and SLNB in Ruijin Hospital increased in last 10 years.Patients had more than 93%of 5-year OS with modern treatment modality of breast cancer,which could indicate clinical management and research in future.

关 键 词：乳腺癌 总生存率 无病生存率 保乳手术 前哨淋巴结活检 

分 类 号：R737.9[医药卫生—肿瘤]